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Biomedical subjects

M Blichert-Toft

Publications and source records attributed to M Blichert-Toft.

At least 199 records · Page 11Linked to original sources
PubMed1977

Late voice function after surgical injury to the recurrent nerve.

In the period 1960 to 1970, a total of 213 patients underwent subtotal thyroidectomy for benign cervical toxic goitre. Postoperatively, immobile vocal cord indicating paralysis of the recurrent nerve was found in 17 patients. In 8 patients, immobility of the vocal cord was permanent. Seven of the 17 patients received voice training which was initiated within 3 weeks after operation. After a period of 5-10 years, on an average 8 years, the 17 patients had a clinical and a comprehensive objective examination of the voice function comprising stroboscopy, electroglottography, phono-oscillometry, voice range, phonation time, peak-flow and pitch. Only a few complaints were ciliated whereas the objective examination of the voice function revealed abnormal findings in all but one patient. The findings were less abnormal in patients who had received early voice training. It is concluded that despite abnormal objective findings, all 17 patients found their voice function satisfactory. Moreover, early voice training seemed to offer a fair chance of minimizing late voice problems, whether the paralysis was permanent or transitory.

Adult↗
PubMed1977

Bile peritonitis due to spontaneous perforation of the common hepatic duct. Report of a case.

A 55-year-old female, previously cholecystectomized, was admitted to hospital with signs of severe acute abdomen. At laparotomy, bile peritonitis was found, but the site of leakage could not be discovered. The biliary tree was otherwise normal and without stones. The treatment was confined to drainage of the common bile duct by inserting a T-tube. In spite of intensive postoperative care the patient died. Autopsy showed a perforation opening in the common hepatic duct on the posterior wall and a solitary stone was detected in the adjacent retroperitoneal tissue. The mechanism to this rare condition is discussed and a review of earlier similar cases is given. The benefit of routine cholegraphy in order to avoid retained stones is briefly mentioned.

Biliary Tract Diseases↗
PubMed1977

Long-term observation of thyroid function after surgical treatment of thyrotoxicosis.

During the 10-year period from 1960 to 1970 a total of 213 patients with diffuse or nodular toxic goitre underwent subtotal thyroidectomy. A short-term preoperative treatment with antithyroid drugs and iodine was given systematically. The observation period ranged from 5 to 15 years, average 9 years. A total of 203 patients (95%) were traced and followed up. The concentration of se-T4, se-T3, and se-TSH was measured and in selected cases a TRH test and BMR was carried out in addition. All thyroid specimens were re-examined by the same pathologist for histological grading. It was found that 85% of the patients had been rendered euthyroid for 5 years or more. The recorded incidence of thyroid hypofunction was 6% and the incidence of recurrent thyrotoxicosis was 9% of the series. Se-TSH was found to be elevated in 17%. The correlation between elevated se-TSH and se-T4 values was calculated and found to be fairly reasonable (r = -0.66). It is concluded that subtotal thyroidectomy preceded by short-term antithyroid drug therapy supplemented ultimately with iodine offers significant advantages in the management of thyrotoxicosis by rendering 85% of patients euthyroid on long-term surveillance.

Adolescent↗
PubMed1976

Comparative study of ultrasound, 131I-19-iodocholesterol scintigraphy, and aortography in localising adrenal lesions.

Twenty-seven consecutive patients with endocrinological disease necessitating adrenal surgery underwent blind preoperative investigation with ultrasound, renal aortography, and adrenocortical scintigraphy for an adrenal lesion. Nine patients had pituitary-dependent Cushing's syndrome, five had pituitary-independent Cushing's syndrome, four had an adrenocortical androgenic excess, and nine had a preoperative diagnosis of phaeochromocytoma. The predictive value of preoperative ultrasound was 100% for a positive finding and 79% for a negative result. Preoperative aortography had a predictive value of 83% for a positive finding and 64% for a negative result; and the predictive value of adrenocortical scintigraphy was 100% for a positive finding and 85% for a negative finding. In localising biochemically suspected adrenal lesions ultrasound should be the first choice, since it is rapid, noninvasive, cheap, and reasonably accurate. Adrenocortical scintigraphy has a similar diagnostic value, especially in Cushing's syndrome, but it is time consuming. Nevertheless, it may be preferable for diagnosing small glucocorticoid-secreting adenomas. Aortography should be reserved for cases with inconclusive diagnoses and suspected extra-adrenal phaeochromocytomas.

Adolescent↗
PubMed1976

Short ACTH test in assessing hypothalamic-pituitary-adrenocortical function.

The adrenocortical response to the simple 30-minute ACTH stimulation test was compared with the hypothalamic-pituitary-adrenocortical (HPA) response to insulin-induced hypoglycaemia in 25 patients with various degrees of hypothalamic-pituitary malfunction. The correlations between the increase in plasma cortisol during insulin hypoglycaemia and that during ACTH stimulation (r = 0-66) and between peak plasma cortisol levels during the two tests (r = 0-90) were highly significant. Peak plasma cortisol levels in individual patients were similar on both tests, no patient showing any major discrepancy between the two test results. Thus the simple 30-minute ACTH stimulation test seems to be reliable in detecting imparied HPA function.

Adolescent↗
PubMed1976

Quantitation of the accelerating effect of metyrapone on cortisol metabolism.

Quantitation of the accelerating effect of metyrapone on cortisol metabolism has been made by determination of the metabolic clearance rate (MCR) of exogenous cortisol during a metyrapone load. Six adrenalectomized patients were studied. The slope of cortisol concentrations in plasma was determined after intravenous administration of 0-3 mg cortisol/kg b.w. with or without metyrapone 17-5 mg/kg b.w./h. In all six patients studied, the MCR of cortisol increased during metyrapone load from an average of 12-3 +/- 5-0 (SD) l/h to 29-6 +/- 15-7 (SD) l/h or corrected for body weight 3-0 +/- 1-1 (SD) ml/kg b.w./min to 7-1 +/- 2-5 (SD) ml/kg b.w./min. The discrepancy discovered in clinical practice between the relatively small rise in plasma total corticosteroid concentration and the greater increase in urinary excretion of corticosteroid metabolites during the metyrapone test may be explained by the findings in this study.

Adrenalectomy↗
PubMed1976

Glucocorticoid maintenance therapy following adrenalectomy: assessment of dosage and preparation.

Plasma cortisol was monitored repeatedly after oral administration of cortisol and cortisone (cortisone acetate) to seven adrenalectomized patients with pituitary-dependent Cushing's syndrome. The amount of glucocorticoid administered was 25 mg cortisol or 33 mg cortisone/g urine creatinine/24 h. Peak plasma cortisol levels were within recommended values in all patients after cortisone and in three of the patients after cortisol. The remaining four patients had elevated peak plasma cortisol levels after cortisol. Transcortin binding capacity in plasma was normal. It is concluded that cortisol as well as cortisone is suitable for oral glucocorticoid substitution therapy in patients with normal liver function, but that cortisone apparently gives a marginally smoother plasma cortisol curve. However, it is essential to monitor plasma cortisol after institution of glucocorticoid maintenance therapy, since different and unpredictable plasma cortisol levels may exist after a given amount of glucocorticoid, although the dose required correlates reasonably well with creatinine excretion in urine.

Administration, Oral↗
PubMed1976

Acute segmental gastro-intestinal gangrene probably of clostridial origin. Report of a case.

A 29-year-old female suffering from acute terminal ileitis was subjected to laparotomy undertaken on the tentative diagnosis of acute appendicitis. The appendix was found to be normal and was removed. The course was complicated with segmental gastro-intestinal gangrene with fatal outcome. The involvement of histotoxic clostridial infection as a causative factor is discussed.

Abdomen↗
PubMed1975

Strangulated diaphragmatic hernia. A clinical study.

Symptoms, signs, and definitions of strangulation and incarceration in diaphragmatic herniation are surveyed, and four patients with strangulated diaphragmatic hernia are reported on. Although the symptoms may be uncharacteristic, the diagnosis is easily made, if kept in mind. X-ray examination of the chest, possibly supplemented by a barium meal, usually indicates the diagnosis. The mortality rate in our series was high, similar to the findings in other series in the literature. Since approximately half of the cases of incarcerated and/or strangulated diaphragmatic hernia are due to overlooked traumatic diaphragmatic rupture, we stress the importance of diagnosing and treating such rupture promptly to reduce the mortality rate. Strangulated diaphragmatic hernia is a clinical entity on the borderline between the fields of thoracic and general surgery. The disorder is often overlooked or improperly treated, possibly because most units have limited experience with this particular phenomenon.

Adult↗
PubMed1975

Human serum thyrotrophin level and response to thyrotrophin-releasing hormone in the aged.

170 healthy volunteers were investigated, and the clinical and biochemical conditions of selection specified. The fasting morning level of serum thyrotrophin (TSH) was determined in all volunteers and found unchanged within the age interval 18-94 years, independent of sex. This is in disagreement with results obtained by other investigators who found an increase of TSH in old age. The implications of the criteria of selection are discussed. Nycterohemeral rhythm was studied in 16 persons. Rhythmic variation was an inconstant finding, and the pattern in the young could not be distinguished from that in the old. The TSH response to thyrotrophin-releasing hormone (TRH) was determined in 53 persons of various ages and found unrelated to age. Nonetheless, the lowest responses were observed in the aged, but the difference was not statistically significant. Possible physiological interpretations of an unaltered TSH secretion in spite of an age-related decrease in thyroid function are discussed.

11-Hydroxycorticosteroids↗
PubMed1975

Virilizing adrenocortical adenoma responsive to gonadotrophin.

A virilizing adrenocortical adenoma was demonstrated in a yound female. Urinary 17-ketosteroid excretion and subfractions, plasma testosterone level and urinary 17-ketogenic steroid excretion were markedly increased. Dehydroepiandrosterone was the main constituent of the androgen excess. Otherwise the adrenocortical function was found to be normal as evaluated from measurements of cortisol, corticosterone and their metabolites under basal conditions and during dynamic tests. The androgen excess showed an unexpected response to trophic hormones. Human chorionic gonadotrophin stimulation resulted in a pronounced increase in androgen production, whereas no gonadotrophin-dependency could be demonstrated by means of the oestrogen suppression test. Similarly, no corticotrophin-dependency could be demonstrated by corticotrophin stimulation and suppression tests. Removal of the tumour resulted in normalization of the androgen production and no abnormal response upon human chorionic gonadotrophin administration could now be found. The inappropriate response of tumours to trophic hormones is discussed. It is concluded that the reliability of stimulation and suppression tests in determining the site of excessive androgen production should be accepted with reservation.

11-Hydroxycorticosteroids↗
PubMed1975

131I-19-iodocholesterol scintigraphy of the adrenal cortex.

131-I-19-iodocholesterol scintigraphy of the adrenal cortex has been carried out in 26 patients. In 4 patients with normal adrenocortical function the tracer was equally accumulated on the two sides. In 7 patients with untreated Cushing's syndrome, bilateral uptake was found in 4 patients with bilateral hyperplasia whereas unilateral visualization was obtained in three cases of cortisol producing adenomas. The side localization was confirmed at operation. Eight patients had been operated for Cushings syndrome prior to the scintigraphy. Remnant adrenocortical tissue with negligible or subnormal function (4 patients) could not be visualized. Normo- or hyperfunctioning remnant tissue was visualized in 3 patients. One patient had recurrent hypercorticism due to metastases from a previously removed adrenocortical carcinoma; a single pelvic accumulation was seen, whereas several metastases in the abdomen and thorax were not visualized. Four patients with aldosteronism were investigated. Three had primary aldosteronism due to an adrenocortical adenoma. In two of these, the site of the adrenal lesion was localized pre-operatively. In the third patient, equal bilateral accumulation of iodocholesterol was seen even after suppression with dexamethasone. At operation a small tumour was found. In 1 patient with indeterminate aldosteronism both glands were visualized and at a second examination the uptake was equally suppressed by dexamethasone.

Adrenal Cortex↗
PubMed1975

Clinical course of cystosarcoma phyllodes related to histologic appearance.

A series of 17 females having cystosarcoma phyllodes underwent surgical treatment. The subsequent clinical course was observed periodically. Twelve patients had originally histologically benign tumors. Six patients had a recurrence, and of these, malignant characteristics developed in four instances. Five patients had originally histologically malignant tumors. Recurrences were encountered in four. Five patients died from a generalized spread of the tumor. Three of these patients had originally histologically benign tumors, in which malignant features of the recurrent tumor subsequently developed. The surgical treatment ranged from local excision to simple mastectomy with additional roentgenotherapy in three. Neither procedure prevented a recurrence from the original tumor, whether benign or malignant. Poor correlation exists between biologic behavior and histologic appearance of cystosarcoma phyllodes, independent of the surgical procedure. Wide local excision in histologically benign and mastectomy in histologically malignant tumors are advised, but no final decision could be reached. It is proposed to restrict ther term cystosarcoma phyllodes to histologically malignant tumors and use the term fibroadenoma phyllodes in instances of histologically benign tumors.

Breast Neoplasms↗